Relative Protective Value of Alkaline Duodenal Juices Against Gastrojejunal Ulceration

Abstract

A review of the voluminous literature which has now accumulated on the relative protective value of the alkaline duodenal juices in preventing ulcer formation reveals a bewildering maze of confusion. Much of this diversity of opinions and contradictory experimental results has been due in great measure to the observations and comparisons made by different investigators under varied and diverse circumstances. Because of the existing difficulty in drawing conclusions from the confusing and contradictory experimental results, this investigation was made.

The investigation was divided into 4 groups of experiments: (1) Group 1—Severance of the pylorus and closure of both the gastric and duodenal ends and the reestablishment of continuity of the gastro-intestinal tract by gastrojejunostomy; (2) Group 2—Exactly the same procedure as in Group 1 but with the addition of transplantation of the common bile duct into the terminal ileum; (3) Group 3—Exactly the same procedure as was performed in the first group but with the addition of ligation and division of the accessory pancreatic (whenever it was found) and transplantation of main pancreatic duct into the terminal ileum; (4) Group 4—Exactly the same procedure as in Group 1 but with the addition of transplantation of both bile and pancreatic ducts into terminal ileum. Obviously all the groups are similar with the exception of one factor, the deviation of bile in one group, the deviation of pancreatic juice in another, and the deviation of both bile and pancreatic juice in the last group. Thus, because of the comparability of the 4 groups of experiments, any difference in results obtained can be accounted for by the one different factor characterizing each group.

A total of 60 dogs was used in the experiment—20 in the first group, 20 in the second, 10 in the third, and 10 in the fourth group. In Group 1, 50% of animals living from 9 to 271 days postoperatively developed typical subacute and chronic ulcers.